Medical Scheme jobs in Good Hope, Western Cape
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View similar jobs with this employerMelomed Private Hospitals SASouthern Suburbs, Western Cape- Interact with patients and medical aid schemes.
- Resolve patient and medical aid scheme queries.
- Hospital or Medical Aid scheme case management would be an…
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- Genesis Medical SchemeObservatory, Western Cape
- Genesis Medical Scheme is seeking a Non-Disclosure Investigator that would be responsible for identifying and investigating suspected cases of member non-…
- Momentum HealthCape Town, Western Cape
- The purpose of this role is to lead and coordinate the recovery of Fraud,Waste, and Abuse (FWA) debt from healthcare service providers on behalf of the medical…
- Melomed Private Hospitals SASouthern Suburbs, Western Cape
- Liaise with the medical aid schemes and patients to resolve account queries/shortfalls.
- Control outstanding medical aid accounts by processing and submitting…
- NMICape Town, Western Cape
- Employee referral scheme with generous financial reward.
- Annual bonus scheme (dependant on company and individual performance).
- Good enough isn't enough.
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- Ten GroupCape Town, Western Cape
- Through this benefit, the company makes regular contributions towards your medical aid plan, helping to significantly reduce your out-of-pocket medical expenses…
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- SanlamCape Town, Western Cape
- Membership to funds and schemes, including medical aid, group life & pension fund.
- Opportunity to market multiple products within the Santam Group product range…
- Sonata OneCape Town, Western Cape
- Fund managers can raise capital faster at a lower cost from a wider pool of pre-approved investors.
- The KYC Analyst – Managed Services is responsible for the…
- NMICape Town, Western Cape
- This role requires a collaborative and adaptable, creative thinker, with hands-on experience in engagement and culture initiatives, HR administration and…
- Ten GroupCape Town, Western Cape
- Through this benefit, the company makes regular contributions towards your medical aid plan, helping to significantly reduce your out-of-pocket medical expenses…
- MRI SoftwareCape Town, Western Cape
- The Lease Administrator will work closely with our clients to help support across all lease management areas.
- Uploading sales data and calculating turnover rent…
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- MRI SoftwareCape Town, Western Cape
- This role is ideal for someone who can independently analyse complex issues and deliver data-driven solutions to clients.
- 12 Apostles hotelCape Town, Western Cape 8005
- Fantastic recommend a friend and family bonus scheme.
- Access to company funded medical benefits for all permanent and hourly paid employees including extended…
- Dis-Chem Pharmacies LimitedCape Town, Western Cape
- Correct errors on scripts rejected by medical scheme.
- Process all paperwork necessary for the accurate submission of claims to medical schemes.
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- Dis-Chem Pharmacies LimitedCape Town, Western Cape
- Correct errors on scripts rejected by medical scheme.
- Process all paperwork necessary for the accurate submission of claims to medical schemes.
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- Corporate TravellerCape Town, Western Cape
- Comprehensive Health Cash Plan: Get reimbursed for a variety of medical services, including dental, optical, and chiropractic care, with our bronze-level health…
Case Manager
Job details
Job type
Full-time
Full job description
- Assess patient conditions and needs to develop appropriate care plans
- Interact with patients and medical aid schemes
- Resolve patient and medical aid scheme queries
- Update all information timeously and accurately
- CPT and ICD coding
- Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of where medical aids request them from their hospitals as part of their assessing process
- Monitor patient admissions and identify those who have limitations, restrictions, place by their managed care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting fees or drugs and/ or formularies
- Maintain a control system that ensures the systematic monitoring of managed care patients
- Handling patient queries
- Update hospital information
- Qualified Registered Nurse
- Minimum 3 years nursing experience in a multidisciplinary hospital.
- Experience and exposure in Theatre and/or ICU would be advantageous
- Hospital or Medical Aid scheme case management would be an advantage.
- Experience in ICD 10 and CPT coding is essential
- Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies
- Excellent communication skills (written and spoken)
- Excellent analytical and problem-solving skills
- Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Kronos, Clinic Manager, etc.
- Attention to detail
- Ability to cope well under pressure
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